AB1791-HPR EVALUATION OF DIAGNOSTIC AND THERAPEUTIC DELAY IN PATIENTS WITH RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS
Authors: M. Iacovantuono, S. Ferrigno, P. Conigliaro, P. Triggianese, A. D’antonio, F. R. Spinelli, A. Bergamini, M. S. Chimenti
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Inflammatory arthritis, such as Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PsA), are diseases that require timely therapeutic intervention to reduce or stop the progression of joint damage and diseases flares. Early diagnosis and rapid accessibility to care lead to a better patient management. <h3>Objectives</h3> We conducted a monocentric study in a cohort of patients affected by RA and PsA to assess factors related to diagnostic delay and accessibility to treatments, in order to improve patients management. <h3>Methods</h3> Between June and September 2022, clinical and serological characteristics, time (months-years) between symptoms onset and the diagnosis and the initiation on csDMARDs-ts/bDMARDs therapy, of RA patients - according to EULAR/ACR 2010 criteria - and PsA patients - according to CASPAR criteria - were collected. In addition we evaluated place of residence (small/big city (&gt;200.000)), who made referral to the rheumatology center, physician who made the diagnosis (rheumatologist/other specialist/family doctor), possible wrong diagnosis previously made. Statistical analysis was conducted using Student T-test/ Mann-Whitney U Test/one-way ANOVA when appropriate, via GraphPad Prism version 8.0.2. <i>P</i> values &lt;.05 were considered significant. <h3>Results</h3> 100 RA patients and 100 PsA patients were included <i>(table I).</i> Statistical significant differences were observed concerning: diagnostic delay (PsA patients 5.2±7.6 yrs vs versus RA patients 2.5±4.6 yrs, <i>p=0.003</i>), time passed between symptoms onset and initiation of csDMARDs therapy (PsA 5.3±7.6 vs RA 2.7±5.1, <i>p=0.006</i>), and between diagnosis and initiation of ts/bDMARDs therapy (PsA 3.5±5.5 vs RA 7.1±8.6, <i>p=0.0007</i>). In the two groups: - In the residents of small and medium sized cities compared to the big cities residents, in the diagnostic delay (6.1±10.2 vs 2±1.8, <i>p=0.02</i>), in the time between symptoms onset and the start of first line therapy with csDMARDs (6.4±10.7 years vs 2.3±1.9 years, <i>p=0.02</i>). - In patients who have been diagnosed by another physician rather than rheumatologist, in the diagnostic delay (4.7±11.1 vs 3.9±6.2, <i>p=0.034</i>) and in the start of I-line therapy (4.7±11 vs 4.2±6.7, <i>p=0.019</i>) In RA: - In the group of patients who had a previous diagnosis - mostly osteoarthritis (35.5%) and UCTD (16.1%) - in diagnostic delay (3.7±6.7 vs 1.9±3.1, <i>p=0.03</i>) and in the time between symptoms onset and initiation of a csDMARD (4±6.8 vs 2.1±4, <i>p=0.05</i>). In seronegative RA: - Delay in diagnosis (4.2±4.7 vs 1.8±4.6, <i>p=0.02</i>) and starting of I-line therapy (4.5±5.3 vs 2±5.1, <i>p=0.03</i>) and II-line therapy from symptoms onset (11.6±9.6 years vs 7.9±7.8 years, <i>p=0.04</i>) compared with the seropositive ones. In PsA: - In patients with previous diagnosis - mostly osteoarthritis (34.1%) and fibromyalgia (19.1%) - in the diagnostic delay (8.1±10 vs 3±4.1, p<i>=0.003</i>), in the time passed between symptoms onset and initiation of csDMARDs (8.1±10 vs 3.1±4.2, <i>p=0.001</i>) and ts/bDMARDs therapy (12±11.1 vs 6±6.5, <i>p=0.0004</i>). <h3>Conclusion</h3> Diagnostic delay is greater in PsA than in RA, in both groups of patients living in small-medium cities and in those who have been diagnosed by another specialist. Major diagnostic delay is present in both groups of patients who have previously been misdiagnosed and in the seronegative RA patients. Consequence is a delayed starting of therapies, with possible permanent joint damage. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.